Abstract
Tumor markers could increase in both tuberculous peritonitis and peritonitis carcinomatosa, confusing the differentiation of these diseases. This study aimed to better understand the extent of elevation and diagnostic efficacies of carbohydrate antigen 125 (CA 125), carcinoembryonic antigen (CEA) and combinative use of them in tuberculous peritonitis and peritonitis carcinomatosa. Of 2998 patients reviewed, 101, 120 and 71 patients were assigned to TBP group (tuberculous peritonitis), non-OCA group (non-ovarian carcinoma-related peritonitis carcinomatosa) and OCA group (ovarian carcinoma-related peritonitis carcinomatosa), respectively. The composite index was calculated by CA 125 multiplying CEA. Receiver operator characteristic curves for CA 125, CEA and composite index were acquired. As a result, CA 125 value in OCA group was higher than other two groups (serum CA 125: P < 0.001; ascites CA 125: P < 0.001). On the other hand, non-OCA group had the highest CEA value among three groups (serum CEA: P < 0.001; ascites CEA: P < 0.001). Area under curves of serum/ascites composite index and serum/ascites CEA were larger than those of serum/ascites CA 125. Furthermore, ascites and serum composite index displayed the best sensitivity (0.907) and specificity (0.989), respectively. In conclusion, CA 125 increases in tuberculous peritonitis and non-ovarian carcinoma-related peritonitis carcinomatosa, but it elevates more in ovarian carcinoma-related peritonitis carcinomatosa. CEA is found to increase more significantly in non-ovarian carcinoma-related peritonitis carcinomatosa. CEA and composite index are helpful in distinguishing peritonitis carcinomatosa from tuberculous peritonitis, but composite index is slightly superior to CEA in the differential diagnosis.
Highlights
Tuberculous peritonitis (TBP) and peritonitis carcinomatosa (PC) are the main causes of exudative ascites
carbohydrate antigen 125 (CA 125) increases in tuberculous peritonitis and non-ovarian carcinomarelated peritonitis carcinomatosa, but it elevates more in ovarian carcinoma-related peritonitis carcinomatosa
carcinoembryonic antigen (CEA) and composite index are helpful in distinguishing peritonitis carcinomatosa from tuberculous peritonitis, but composite index is slightly superior to CEA in the differential diagnosis
Summary
Tuberculous peritonitis (TBP) and peritonitis carcinomatosa (PC) are the main causes of exudative ascites. It is important to distinguish TBP from PC for their different treatment strategies and prognoses. Bacteria culture and interferon-γ release assays (IGRAs) are not able to solve the problem completely since bacteria culture is timeconsuming with limited sensitivity of less than 80% [2], and the long waiting period for the result might compromise the prognosis of tuberculosis [3]. IGRAs require high cost and complicated technology [46], making it unavailable in remote areas. As IGRAs were mainly applied to pulmonary tuberculosis and high risk group [7,8,9,10], it is still uncertain whether IGRAs are conferred to enough sensitivity and specificity in extrapulmonary tuberculosis [11]
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